Incontinence can often be the result of a miscommunication between the brain and the bladder and/or bowels. Sacral neuromodulation therapy works to re-engage proper communication between the brain and the sacral nerves that control the bladder and bowels. Incontinence Institute offers three implanted sacral neuromodulation devices:
How does Axonics therapy work?
Axonics therapy works by stimulating the sacral nerves with tiny electrical pulses. The brain and the sacral nerves don’t communicate properly in individuals experiencing urinary or fecal incontinence. Axonics therapy works to better regulate the sacral nerves’ function. These nerves can then interpret signals from the brain and pass them on to the surrounding pelvic floor muscles, which restores normal bladder and bowel function.
The goal is to restore the normal functioning of the sacral nerves and reduce the improper signaling that can cause leaks, the sudden urge to go, or going too often. The symptoms of an overactive bladder or bowel incontinence are effectively eliminated by the stimulation from the Axonics device.
Axonics is an option for patients who have not responded to more conservative treatments such as changes to diet, medication and physical therapy.
What’s the procedure for getting an Axonics device?
Trial period and evaluation: Axonics therapy begins with a two-week trial period employing a wearable, external version of the device to determine if the treatment is likely to be effective for a patient.
Surgery: If the trial produces positive results, the device is implanted in a patient’s lower back near the sacral nerves.
Post-surgery: After surgery, your doctor will configure the device’s electrical signals based on the results from the trial period.
Axonics Therapy Trial Period
Axonics therapy offers a trial device that simulates the actual, implanted device. The doctor places a lead connected to a small, externally worn device during a 15-minute, minimally invasive outpatient procedure. The external device is worn underneath the patient’s clothing.
The trial period is normally between 5-14 days, to determine whether a permanent device is a good choice. During this time, patients keep a symptom log to discuss with their doctors. They can continue about their normal routines and see what it would be like to live with Axonics therapy, how it feels when activated, and if the permanent device will be able to reduce or eliminate their symptoms.
How is an Axonics device implanted?
The procedure to implant Axonics can be quickly and safely performed at an outpatient surgery center through a minimally invasive surgery. Often only local anesthesia is used, though some doctors prefer to use general anesthesia. The device is inserted in the lower back, above the buttocks. The procedure itself typically takes between 20-30 minutes to complete.
Though insurance plans vary, Medicare and private insurance generally cover Axonics treatment, but please consult with your doctor and insurance company.
How long does it take to recover from surgery?
Patients typically return to their normal activities within three weeks. Light activity is usually possible within a few days after surgery.
What to Expect After the Device is Implanted
Patients may notice a slight feeling of pulling or tingling. It should not be painful — if it is, contact your doctor. A sudden movement can also cause the sensation of stimulation to change because the device has moved closer to or further from your sacral nerve. This doesn’t mean the level of stimulation has changed. Most patients also report that they no longer notice the electrical impulses after a few weeks.
The goal is for Axonics therapy to help patients return to normal activities without worrying about the risk of bladder or bowel leaks. A successful procedure should help patients be more confident of their ability to resume activities they were previously afraid to do because of bladder or fecal incontinence. Long walks, traveling or visits to a movie theater — things that can be difficult when patients are grappling with fecal or urinary incontinence — may now become a possibility for patients.
How do I program or manage an Axonics device?
Patients have a hand-held programming remote that allows them to turn down or turn off the Axonics device if needed. Doctors may also program the device to turn on and off at regular intervals if constant stimulation is not necessary.
Will I be able to see the Axonics device through my skin?
No, you will not be able to see the Axonics device through the skin once implanted.
Can the Axonics device be removed?
Yes, the device can be removed. In the unlikely event that the procedure is not effective, it can easily be reversed.
Can I get an MRI with Axonics?
Yes, Axonics is compatible with a full-body MRI, so you don’t need to have it removed in the event you need an MRI. Please talk with your doctor for more information.
What are the differences between Axonics, InterStim II and InterStim Micro?
- About the size of a quarter, 23 mm x 45 mm
- Requires wireless charging for about an hour, once a month
- Needs to be replaced about every 15 years
- About the size of a silver dollar, 44mm x 51 mm
- Doesn’t require recharging
- Needs to be replaced about every five years
- Smallest SNM device available, 17 mm x 47 mm
- Requires charging for 20 minutes, once a week
- Needs to be replaced about every 15 years
Axonics Therapy for Urinary Incontinence
Bladder incontinence affects over 25 million Americans. There are many causes, including injury or trauma to the pelvic region or back, enlarged prostate or prostate cancer, pregnancy or childbirth, neurological disorders, estrogen loss following menopause, other health conditions like multiple sclerosis or suffering a stroke.
Effectiveness of Axonics Therapy for Urinary Incontinence
93% of Axonics patients were satisfied with their therapy according to the ARTISAN-SNM study, which reviewed patients after one year of therapy:
- 75% overall reduction in urinary urge incontinence episodes
- 77% of participants had a greater than 75% reduction in urinary urge episodes
- 29% of responders were completely dry and had no incontinence episodes
- 88% average reduction in large leak episodes
- 74% of participants had a 100% reduction in large leaks
Study participants also recorded significant quality of life improvements in areas of sleep, concern, social interaction and coping.
Axonics Therapy for Bowel Incontinence
According to a report from the University of Rochester, fecal incontinence affects as many as 18 million Americans. The most common causes are aging or injuries from giving birth.
Effectiveness of Axonics Devices for Bowel Incontinence
According to the ARTISAN‐SNM study:
- 58% reduction in fecal incontinence symptoms
- 91% of participants reported being satisfied with Axonics therapy for their bowel symptoms
Axonics Therapy History
Axonics is a relatively new device, having received FDA approval in September 2019. Since then, two new generations of devices have been approved, both of which have decreased the device recharging requirements. The third-generation Axonics device, available as of March 2021, also allows patients more ability to manage their devices using the remote control and manage symptom relief.
Who is a good candidate for Axonics therapy?
Axonics can be an excellent choice for patients who haven’t experienced success with more conservative treatments, specifically men and women suffering from the following conditions:
- Overactive bladder
- Urinary or bowel urge incontinence
- Non-obstructive urinary retention
- Chronic fecal incontinence
But it’s not ideal for all patients, including patients who:
- Lack the motor skills needed to operate the Axonics system
- Are not good candidates for surgery
- Suffer primarily from stress incontinence
- Experience urinary retention due to benign prostatic hypertrophy (enlarged prostate)
- Cancer or urethral stricture
These therapies may also not be a good choice for patients who are pregnant, are under the age of 16 or who have neurological issues as a result of a chronic condition such as diabetes or multiple sclerosis, since the safety and effectiveness of the treatment has not been established in these populations.
If you’ve tried conservative approaches for your urinary or fecal incontinence and your symptoms still interfere with your activities of daily living, Axonics Therapy could be right for you. Contact our team of expert urinary and fecal incontinence doctors at our office in Nashville, TN.